目的评价将直线切割缝合器应用于脾切除贲门周围血管离断术中的安全性及效果。 方法前瞻性收集2013年6月至2014年5月期间于笔者所在医院行脾切除贲门周围血管离断术的46例肝炎后肝硬变继发门静脉高压症患者的临床资料，根据脾切除贲门周围血管离断术中直线切割缝合器的应用情况分为对照组18例（术中未使用直线切割缝合器）和观察组28例（术中使用直线切割缝合器），比较2组患者的疗效指标。 结果2组患者均顺利完成手术，无围手术期死亡及肝性脑病发生。对照组患者的手术时间、术中出血量、术中输血比例及术后24 h引流量均长于（或大于）观察组（P＜0.05），而2组患者的术后住院时间比较差异无统计学意义（P＞0.05）。术后所有患者均获访，随访时间为4 d～10个月，平均4个月。随访期间所有患者均无消化道再出血发生，脾功能亢进得到完全纠正，生活质量满意。 结论将直线切割缝合器应用于脾切除贲门周围血管离断术是安全而有效的，其简化了手术操作，减少了手术创伤，值得临床推广应用。
A simple model of canine auto-trasplantation of liver was set up by ourselves, and the effects of hepatic artery ischemia (HAI) on ultrastructure of liver and biliary duct transplanted were observed. The results showed that the liver and biliary cells swelled slightly, mitochondrial matrix was loose and ridges were vague just often perfusion. Afte HAI for 3 hours the edema of hepatic and biliary cells aggravated cytoplasm was loose, mitochondria enlarged and partly vacuolar degenerated, ridges broke or disappeared, flocculent focal densites was seen in the matrix, endoplasmic retculum distended obviously, and the ribosome depolymerizated. So we consider that HAI causes obvious damage to hepatic and biliary cells. These indicate that HAI is one of the important factors of complication after liver transplantation, especially some biliary complications.
目的 探讨经阑尾结肠灌洗一期切除吻合治疗梗阻型左半结肠癌的效果。 方法 回顾性分析2009年1月至2011年12月期间于笔者所在医院行经阑尾结肠灌洗＋左半结肠切除术的46例梗阻型左半结肠癌患者（灌洗组）及行左半结肠切除术的114例无梗阻型左半结肠癌患者（对照组）的临床资料，比较2组患者的效果指标。 结果 2组均无围手术期死亡及吻合口漏发生。灌洗组和对照组的术中出血量〔（195±64）mL比（184±66）mL〕、术后住院时间〔（10.6±4.2）d比（10.1±3.3）d〕、住院费用（22 310元比22 650元）、切口感染率〔4.3%（2/46）比3.5%（4/114）〕、腹腔积液发生率〔4.3%（2/46）比2.6%（3/114）〕及总并发症发生率〔8.7%（4/46）比6.1%（7/114）〕的差异均无统计学意义（P＜0.05），但灌洗组的手术时间〔（156.7±16.6）min比（120.6±15.9）min〕及术后肛门排气时间较长（78 h比70 h），P＜0.05。 结论 经阑尾结肠灌洗一期切除吻合治疗梗阻型左半结肠癌安全、有效及便捷，值得临床推广应用。
The model of acute hemorrhagic necrotizing pancreatitis (AHNP) was produced by retrograde forced injection of autogenous bile into the main pancreatic duct. The result showed that urgent surgical (transduodenal) intra-pancreatic duct drainage reduced the mortality rate of the experimental animals. Keeping the drainage patent and clear can both abate the pathological changes and promote the renovation of the dogs pancreas. So it can guide the clinical treatment in some way.
目的 总结分析原发性甲状旁腺机能亢进症再手术的原因。方法对我院1980年至1999年收治的8例原发性甲状旁腺机能亢进症术后因症状持续存在或复发而行再手术的病例，并结合有关文献对其原因进行了总结分析。结果 首次手术失败主要原因： ①多个腺体发生病变(4例)； ②病变腺体异位(5例)； ③医生经验不足(5例)； ④冰冻切片诊断错误(2例)； ⑤残留腺体增生(1例)； ⑥存在第5个或以上甲状旁腺腺瘤； ⑦甲状旁腺癌复发。结论 结合术前定位检查，并熟悉掌握甲状旁腺病变正常和异常的位置，可以提高原发性甲状旁腺机能亢进症首次探查术的成功率。
Since 1995, 8 patients with unresectable carcinoma of pancreatic body and tail has been treated by regional chemotherapy. 5-Fu and MMC were administered through a subcutaneous placed drug pump connecting to the splenic artery catheler. Twelve patients with unresectable pancreatic carcinoma being treated by peripheral venous chemotherapy were as control. The results showed that median survival time with regional chemotherapy with drug pump group as 7.0 months, and the time of peripheral venous chemotherapy group as 4.2 months. The difference between them was significant. This therapy was effective to prolong survival time of patients with unresectable pancreatic carcinoma.
ObjectiveTo study the techniques of mimicking multifactors induced acute pancreatitis in rat by slow-release pump. MethodsSeventy-five healthy SD rats were randomly divided into slowrelease pump group (SRP group), traditional group (TAP group), and sham operation group (SO group). Four percent sodium taurocholate was injected through pancreatobiliary duct of rats directly and retrogradely in TAP group and by slow-release pump in SRP, which mimicked AP pathogenesis from selfdigestion, obstruction, cytokine activation, and many other mechanisms. Detection of serum amylase and pancreatic myeloperoxidase (MPO) leves, observation of pancreatic histological changes and scoring of pancreatitis severity in three groups were performed at 1, 6, 12, and 24 h after successful model induction, respectively. ResultsSerum amylase and pancreatic MPO levels, and the pathological grading score of rats were significantly higher in SRP and TAP groups than in SO group at different time point (Plt;0.05 or Plt;0.01), while they were lower in SRP group than in TAP group with a slowly rising tendency, and there were significant differences at 6 and 12 h time point, respectively (Plt;0.05 or Plt;0.01). Conclusions Slow-release pump technique can induce AP through increasing the pressure of pancreatic duct, tissue edema and sustained releasing inflammation factors by mimicking the pathophysiological process of pancreatitis. Slow-release pump can be kept in place to monitor and control the pressure of pancreatic duct. Slow-release pump method is relatively moderate and easy to manage with a lower mortality.
ObjectiveTo analyze effect of percutaneous transhepatic choledochus drainage (PTCD) for hilar cholangiocarcinoma. MethodsClinical data of 67 cases of hilar cholangiocarcinoma who treated in our hospital from Jan. 2005 to Dec. 2010 were retrospectively analyzed. ResultsOf the 67 cases, 30 cases were performed PTCD, 20 cases were performed radical surgery after PTCD, and 17 cases were performed palliative surgery after PTCD. There were 59 cases who were followed-up for 3-30 months, and the median time was 9.3 months. The median survival time of patients who underwent PTCD, radical surgery, and palliative surgery were 10.2, 21.4, and 8.9 months respectively. The survival of patients who underwent radical surgery was better than those of underwent PTCD (χ2=13.6, P=0.000 4) and palliative surgery (χ2=15.2, P=0.003 8), and survival of patients who underwent PTCD was better than patients underwent palliative surgery (χ2=5.3, P=0.040 1). ConclusionsPTCD is contribute to preoperative diagnosis and evaluation, in addition, it can reduce unnecessary surgical exploration, guarantee the safety of the radical surgery, and provide follow-up care for palliative operation channel which is favorable for local internal radiation therapy.